Following the passage of the National Cancer Act, the National Cancer Program, in addition to funding basic research, supported the training of cancer specialists and established a network of academic and community-based cancer centers. In 1973, the first specialty boards in medical oncology were administered. By 1980, the number of medical and radiation oncologists had increased from a few hundred specialists to several thousand. Further, by 1980, it had become evident the national mortality rate for a number of advanced, formerly fatal cancers, was beginning to fall as new and effective treatment regimes were being incorporated into the care of patients with these diseases, at the community level. Institutes ' (NCIs') programs, which monitor cancer
Five year survival data from the National Cancer incidents survival in twelve percent of the U.S. Population, indicated that survival for all patients diagnosed with serious visceral cancer had increased from 38% in 1963 to 48% in 1980. Striking changes in survival were being documented in patients with a number of disseminated cancers such as acute lymphocytic leukemia, Hodgkin's disease, soft-tissue sarcoma, testicular cancer, and a variety of other pediatric neoplasms in which major breakthroughs in treatment had occurred, as well as in women with breast cancer following adjuvant therapy. While survival data provided gratifying evidence that substantial progress against cancer had been made, they also emphasized that a five to ten year lag existed between the identification of a curative therapy and its acceptance by the medical community and widespread application in patient care. This clearly suggested that significant increases in patient survival could be achieved with a wider and more rapid dissemination on information effective treatments.
A unique feature of the National Cancer Act of 1971 was a provision that enabled the NCI to establish a National Network of resources that would facilitate the development of effective methods to prevent, diagnose, and treat cancer. In addition, the Act gave NCI responsibility for developing new improved methods to disseminate information on advances in cancer research. However, the act included the words "insofar as feasible" in its language and indicated that the Congress clearly recognize that there were obstacles in 1971 limiting the Institutes' ability to fulfill the mandate. For example, there were few trained medical radiation and pediatric oncologists either at academic institutions or in private practice to care for cancer patients and develop or deliver effective cancer treatments. There was a critical need for a network of institutions specializing in cancer care where physicians could send patients so that they would not have to travel great distances for treatment. For these reasons, the Congress gave special resources to NCI to develop treatment resources throughout the country and an information dissemination program to make the most current information on progress against cancer readily available.
Thereafter, an International Cancer Research Databank (ICRDB) was created to foster the rapid and effective exchange of information on cancer research throughout the world. NCI surveyed an international group of 250 basic scientists and clinical investigators in an attempt to define what services would best meet the needs of the international cancer research community. The Institute decided to build its new information program using computers so that the information could be updated and enhanced over time The NCI developed CANCERLINE databases. These updatable files resided in machine-readible form in the memory of a central computer which could be accessed by computers with software that communicated with the central computer.
The first on-line information system, developed by the ICRDB program, was a bibliographic database called CANCERLIT, which was created in 1974. The data base was composed of 42,000 citations taken from Carcinogenesis Abstracts and Cancer Therapy Abstracts, two abstract journals of the mid-1970s NCI then made CANCERLIT widely available to the medical and scientific community over the National Library of Medicine (NLM) computer system and searchable within a command language used by the Medical Literature Analysis and Retrieval System (MEDLARS) databases. In an attempt to ensure CANCERLIT as a comprehensive resource, many books and journals were screened, indexed and abstracted However, the CANCERLIT database did not provide information on research in progress.
NCI then developed, through their staff of the ICRDB, a new computerized database called CLINPROT (Clinical Protocol), to disseminate information on investigational treatment protocols supported by NCI. Each CLINPROT record was created using full clinical research protocol as the source document. Protocol summaries of 1000 to 5000 words were constructed, with special index terms that allowed users to receive protocols by tumor type and treatment. CLINPROT also used the specialized command language of the MEDLARS database While the CLINPROT database added a new dimension to research information, collective and disseminated, by the NCI, the protocol summaries were not indexed by stage, histolic type, or participating investigators and institutions. Therefore, it was difficult for physicians to identify clinical trials appropriate for cancer patients that were being conducted in a particular location. Further, CLINPROT did rot provide information on state-of-the-art treatment CLINPROT merely served as an on-line catalogue on clinical research that provided physicians who were designating treatment protocols with information on research performed by others, thereby minimizing duplication of effort. Further, as with all MEDLARS databases, effective information retrievals from CLINPROT required knowledge of the NLM's specialized searching language.